Provider Demographics
NPI:1659709293
Name:LEE, NELDA (PLPC)
Entity Type:Individual
Prefix:
First Name:NELDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1662
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-1662
Mailing Address - Country:US
Mailing Address - Phone:573-253-3144
Mailing Address - Fax:573-814-1557
Practice Address - Street 1:701 VANDIVER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2094
Practice Address - Country:US
Practice Address - Phone:573-253-3144
Practice Address - Fax:573-814-1557
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional